67: Things Aren’t Always What They Seem

67: Things Aren’t Always What They Seem

If you make listening and observation your occupation, you will gain much more than you can by talk.

~Robert Baden-Powell

I had several years of hospital work experience behind me when I made the switch to community-based home health care. I loved the idea of being one-on-one with my patients, and especially seeing them in their home environment. My assigned territory with my new agency took me to a neighborhood where many people would hesitate to go. My initial trepidation was quickly replaced by a sincere appreciation for the people who lived and persevered in this often dangerous and generally neglected neighborhood.

Mrs. Johnson was first on my list. As I drove up to her tiny clapboard house, I saw the curtain on the front door window immediately pulled aside. She watched me as I sat in the car, documenting my mileage and time and gathering the necessary paperwork and equipment. I saw the curtain continuously twitching back and forth, and thought to myself, “Another Nervous Nellie.”

Things Aren’t Always What They Seem

If you make listening and observation your occupation, you will gain much more than you can by talk.

~Robert Baden-Powell

I had several years of hospital work experience behind me when I made the switch to community-based home health care. I loved the idea of being one-on-one with my patients, and especially seeing them in their home environment. My assigned territory with my new agency took me to a neighborhood where many people would hesitate to go. My initial trepidation was quickly replaced by a sincere appreciation for the people who lived and persevered in this often dangerous and generally neglected neighborhood.

Mrs. Johnson was first on my list. As I drove up to her tiny clapboard house, I saw the curtain on the front door window immediately pulled aside. She watched me as I sat in the car, documenting my mileage and time and gathering the necessary paperwork and equipment. I saw the curtain continuously twitching back and forth, and thought to myself, “Another Nervous Nellie.”

Some folks got genuinely agitated about having a stranger in their home and I anticipated wasting time on allaying her fears. But after Mrs. Johnson ushered me inside, and quickly locked and bolted the door, she sat on her sagging couch and smiled expectantly at me, her bright, intelligent eyes showing no sign of worry or fear.

I proceeded with my detailed assessment, ticking off a long list of health-related questions. We spoke at length about her medical history and I explained the primary reason for my visit. There were concerns about her blood pressure and uncontrolled diabetes after a recent hospitalization, and her physician wanted home health to work with her to get both of these under better control. I quickly checked her vital signs, reviewed her medications, and began to discuss my goals for her plan of care.

“Is there anything else going on that I need to know about?” I asked her at last.

“Well” she said hesitantly, “I don’t sleep well at night.”

“Okay,” I replied, thinking this was pretty minor and not unusual with elderly people. “We’ll see how that goes over time,” I said, making a notation on my form.

I finished my paperwork and took my leave. Mrs. Johnson showed the same haste and agitation she had on my arrival.

This became her usual pattern. I talked about diabetes and hypertension. Mrs. Johnson listened quietly, followed my instructions, but continued to make reference to her ongoing inability to sleep. She was still waiting nervously at the door when I arrived, and watched constantly after I left until I pulled away from the curb. After several weeks, she showed marked improvement in her blood pressure and blood sugar readings. I felt pleased with my ability to help her achieve these established goals and knew our visits together would soon come to an end. I felt, since our primary goals had been achieved, we should address her persistent sleep issues.

“So, why don’t we talk a little bit more about your sleep problems?” I finally asked her, thinking a call to her primary physician might be in order. “Maybe your doctor would want you to have a sleeping pill.”

After some hesitation she said, “Oh, it’s not like that. I don’t need a sleeping pill.”

“Why don’t you tell me what you think the problem is? Obviously this is something that has been bothering you for a while.”

Taking a deep breath, Mrs. Johnson began. “Oh honey, I am so worried about you when you come to see me early in the morning like this. See that empty lot behind my house?”

Now I was really confused, but I said that I did, wondering how this had anything to do with anything.

“Every night when the sun goes down,” she continued, “those drug dealers come out and hang around the back of the house there. Now, my bedroom is in the back of the house, and there’s no way I’m sleeping in there, what with all the shooting, and fighting, and bullets whizzing by. No sir! This old house is nothing but boards and I might get shot right there in my bed! So I come out here and sleep on this old couch.”

I looked at the sagging couch in dismay, visualizing this precious lady trying to get comfortable on that lumpy old couch with visible springs poking through. And the walls were, in fact, nothing but the inside of the outside clapboards, and I could see daylight between most of them. But she wasn’t done yet, and her next words dismayed me.

“I am so afraid for you when you come here in the morning. Sometimes those drug dealers are still out there, and I’m scared to death somebody will shoot you. I just don’t have a moment’s peace until you are safely inside this door. And you know I don’t see that well, so when you leave, I wait to hear your car pull away; then I know you made it back to your car and are safely on your way.”

As I looked into the face of this little lady who had endured so much, I was overwhelmed and ashamed. I had made judgments about her, decided what was best for her, and established an agenda that never once included issues important to her. And all the while, her concern was only for me.

Obviously, I could not change how or where she lived or eliminate the criminal element in her neighborhood. I realized, though, that a few modifications in my behavior could make a big difference in reducing her stress and worry.

For the remainder of the time that I saw her, I did not do paperwork in my car. I went into her house promptly and left the same way. It gave her peace of mind and gave me the satisfaction of knowing I made her day a little easier.

Now, many years after that eye-opening experience, I know I am a better nurse for having known Mrs. Johnson. It’s great to have goals and a plan, but real nursing care takes your patient’s needs and feelings into account first. I have learned to be a better listener, to judge less, and to adapt my goals based on my patient’s priorities rather than my own.

Most importantly, I have come to realize that things aren’t always what they seem. And sometimes, that’s a positive learning experience for everyone.